Monday, 30 January 2017

Anger among Ugandans has nothing to do with President Y.K. Museveni; it has everything to do with expectations out of the Oil



It is symptomatic, it is historical, it is cumulative and has been undiagnosed since 1962. The fuel is:  internal unrest between 1966-1971, the debauched war to topple Amin, the international embargo against Uganda during Amin's regime, the devaluation of the Uganda shilling with promise to compensate people that was not fulfilled, the 1979 war, the 1983 Bush war, the promises to compensate those who lost property in the wars which were fulfilled for some and not others and the impact of HIV.


My late grandfather served as one of the first chiropractor-medical assistant in various places in Uganda including Mbarara and Masaka. He retired in the 60's. His children were educated in various schools. My father won an Engineering scholarship which took him first to Britain, Italy, Germany and then Brazil. In Britain, he excelled at the Guy-Leyland Industry, in Italy he beat the computer at assembling a Fiat engine. He helped improve circulation and reuse of oil in diesel engines. He was enticed to remain in Europe but chose to come back to Uganda. The Amin regime did not agree well with his types. He was unceremoniously asked to leave his job as the Government Vehicle Inspector. No compensation was made. He was forced to start afresh. I am sure there are many stories like these in Uganda. 

I can pointedly say more anger among Ugandans was furiously and fiercely stalked or reignited  by the occurrences between 1979-1986. HIV brought its strain of anger. This anger has never been fully assuaged. The early collective mind of a Ugandan black African in the early days of the HIV disease took on a multi-faceted dimension. In the earlier days (early 1980's) following the 1979 Liberation war many things happened simultaneously. 

A regime change that ushered in the road to democratic governance. People who committed atrocities were brought to trial. Others were not. Some who lost property, were compensated but others were not.  There were rumours of a disease far away from Kampala City Authority's comfortable zones. Othering those who had the disease became the norm. A vacuum and disconnect between those who were to provide services and recipients opened up. 5 litre jerry cans of herbal medicines that cost a limb became the symbols of self care in many a homes. It was a field day for unregulated herbalists. My own father sold all his 6 Bunga-Ggaba estate mansions plus the sprawling well manicured 8 acre land attached as he fought for his and the life of the wives. An insurance supported by government would have helped but, it was non existent. Today, the case of access to ARV's warrants an entire article on its own.
Meanwhile, it is still open market for the herbalist and other providers who promised cures which are not real.

Between 1979-1986, Uganda experienced tensions at political, social and cultural levels which in turn affected the way people experienced life and decided on what to prioritise. A mass austerity automatically kicked in even without the government's say so. People made austerity practices that affected food provision, sleeping arrangement, mobility, choices for wellness and investing in quality life. People became a dumping ground for trauma characterized by severe deprivation and living in squalid conditions. This has gone on even after it has been established that Uganda has one of the best government systems in Africa today. Somehow, this trauma has demotivated many from taking initiative. Not even "entandikwa," "ennyongeza" "bonna baggagawale," and other programmes can be carrot or stick enough. But, this does not give Uganda any excuse not to provide ways to addressing many unmet past recession, depression and austerity episodes. Another article will explain the meaning of President Y.K. Museveni's remark: "...I am not any body's servant. Me, I am a freedom fighter...." But quickly and as a scholar of intercultural communication. This message was not meant to posture or position himself as an isolationist. In fact, he was a proud elder about to surprise a clan with a bull roasting feast. It was a preamble! But, let me not digress. We were talking about Uganda's need to adorn the mantle of a true welfare state now that she has Oil.

Other countries went through periods of recession, depression and austerity because of war, cataclysm or government policy. Ireland, Germany, U.S. (What was 'The Great Recession') and many African countries come to mind. Austerity with hope in a government that will come around to address historical wrongs in all the spheres at political, community and household level is galvanizing. The U.S. has gone through periods of austerity and two come to mind: The Depression, the 2008 recession and the 2013 government shutdown did not stop the The U.S. social systems to provide a minimum redress. This gives people hope.

Hopefully Uganda which has gone through traumatizing events can use say, Oil, to heal wounds and provide spaces of hope for diverse communities. It will be possible to help many who may privately be grieving not only for HIV but loss of property due to wars. This grief followed the 1979 war, the "war in the bush" and HIV/AIDS.


Friday, 27 January 2017

Indefatigable David Kato!

".....we should try as much as possible to promote awareness around HIV and then show the ease with which it is transmitted among LGBTIQQ. I thank you for bringing the public health angle to the activism we are doing. I am part of an organization called Integrity. It is a spiritual support group and our Pastor is Bishop Ssenyonjo Christopher. You should come to one of our fellowships one of these Sundays....." 


This was in 2004, and these were the words David Kato shared, animatedly, with me over a cup of coffee downtown Kampala. After watching what David Kato was doing since 2002, I noted we shared a philosophy. We shared the concern over the link between HIV transmission and the myth doing the rounds that no one caught any disease through anal sex! 

David Kato told me that he was a great friend of  the Justice of the Constitutional Court, Edwin Cameron who in 1997 announced that he had been living with HIV. David's work with Judge Cameron (SAHO, 1999) involved raising awareness on how HIV/AIDS spread and how to prevent it.  This was while he lived briefly in the Republic of South Africa. He also did some work there with the AIDS Consortium and AIDS Law Project. David Kato was brilliant, a problem-solver, incisive, decisive and one who would not hesitate to stand his ground if he had made up his mind. He struck me as a good listener, he asked pointed questions and was a mentor too. I had a problem with my mobile phone in 2004 and helped me learn how to lock it securely as well as use the different applications. The 30-45 minutes he spent taking me through the steps showed me another side of David Kato. David  made it possible for me to understand activism in Uganda. I am sure, there are many who will agree with me.

I had been in three earlier events where David Kato was a participant too. The first event was in 2002 (GLAD) at a meeting organized by Evangelical Scott Lively of USA to coordinate with anti-gay/Family Life Network's Stephen Langa and Martin Ssempa. All this talk about a gay-agenda and a counter gay-agenda was exciting to say the least. It almost pulled the rug from under me in some ways. I never looked at anyone as a gay person but as a human being. My concern for caring for people living with HIV must have made me look at the world differently. But I guess the organizers being Bible people and Pentecostals for that matter, anything framed in the bounds of Genesis 19-29 had to call for praying over, instituting legislation and penal codes. Anyway, at the meeting we were introduced to the Uganda anti-gay strategies. Spies and saboteurs of this great plan, which included among other things arcane therapies and healing by touching, were cautioned. That meeting galvanized many who were in that large auditorium.  As a medical person, I still did not see the need for legislation on sexuality, gender, orientation and identity.  I knew there can be biological and cultural gender. I know nurture and nature work hand in hand in this phenomena. All the while, David Kato was noting down points.

David Kato Photo courtesy of Economist


The second event was during an informal meeting to come up with an understanding of what and who was doing what for the LGBTIQQ community. It was a kind of inventorying. I was an outsider and therefore, could feel that not so much was being said by others. It was clear, I and some other allies were being tested. There were rumours of crackdown by authorities and they were not unfounded. Arrests were made of people who were suspected of homosexuality and homosexual activities.  I had some other duties to do elsewhere so, when I had finished talking about our organization I left. But, before I left I recall David Kato asking to meet during the weekend for coffee. I guessed it was his way of finding the middle ground. We never met for the coffee. 


The third occasion happened through another event. I had met Dr. Mugisha Frank back in April of 2005 (after Easter holidays). Dr. Frank asked to help him organize Icebreakers (IBU) to fulfill a vision he had shared with me. I accepted and began an intense work for three years up to when I left in 2008. By the time I left IBU, I had shared with them all my networks and helped beef up its fan base. I helped develop logic performance tools and co-designed the codes for running the organization. We went our separate ways and it enabled me concentrate more on my vision of  quality life and wellness for all irrespective of background, status and culture.

In doing my work around public health and that of Icebreakers we met with David Kato on a few occasions. It was around this time that I was called to SMUG offices for a meeting. In those early and formative years of  SMUG, I remembered being curious to meet the bold members as well as finding out what SMUG's vision was.  So, when I was invited, I felt so honoured. Dr. Frank Mugisha was supposed to introduce me to the SMUG board of that time (David Kato was a member as well).  We went up to the gates and Dr. Frank asked me to stay outside while he went to check. He told me it was a security precaution they had devised. So, he went to consult with the board members to see if I could be admitted. He came back and told me I was not welcome at SMUG (yet).  I remembered I had left my workplace that particular day, with an excuse of going home to nurse my grandmother. So, I stoically walked the lane of shame and left to go back to my home. I came to know that people who have grown up fighting for their self-identity, fending for crumbs of space and at the same time hiding their sexuality when it suits, have relied on cues to translate contexts. They can be suspicious of someone who comes from the blue to "help" them or join ranks untested or unsolicited. As a professional person, I used these lessons to my advantage.

At 7:00 pm that evening, I got a call from David Kato who apologized on behalf of SMUG. He told me I was still perceived as a government spy and the leaders failed to place me well. I asked what "they" meant by not placing me well. He decried my lack of socializing, not a smoker, nor a drink and not being a party-goer. I rebutted by saying I instead used my time differently. I shared with him my love for cultural theatre, movies and concerts.  I actually told him, public health work for LGBTIQQ requires community visits and we compete for a time slot when we are off our official government work, when people are at home or not at work for those who are occupied with something. I even told him that I volunteer at Sanyu or Nsambya Babies' Home. In other words, it was a matter of priorities really. My having to explain myself, demotivated me further and from that day, I knew activism was to be gauged by one's boots on the ground. Actually, up to this day I see different brands of activism. I am more inclined to health rights activism. I get fired into action when there is blood drawn, sickness, or a cry of pain. I have also worked in the world of red tape and paperwork that goes with documenting an aspect that needs an intervention. I have learnt how to prepare myself to be appropriate in communicating my needs and appreciation.  When I contemplated the differences in our work, I knew I had to build my own organization so that the next time I ever met anyone from SMUG it was to be at a different power-play level with a win-win outcome. Working with SMUG, has its advantages and one of them is relating with movers and shakers in the LGBTIQQ Community.

David Kato and Dr. Paul Semugoma, among others, helped me to build the kind of organization I had in mind. With time, it was possible to work with SMUG and other organizations that are not part of it even today. SMUG as an umbrella organization has only got four organizations (Integrity, Spectrum, Icebreakers and FARUG) that comprise this umbrella. Uganda has around 75 organizations doing impacting and useful work with a very wider reach. I have personally met, worked with different organizations and I vouch for their necessary impacting work and tangible deliverables. We continue working with many other people and organizations in Uganda other than SMUG even todate. In all my experiences up to 2011, David Kato was a perennial witness and he presided over some of our community health talks and dialogues.

But, what makes me remember David Kato was his humility, sense of duty and articulation. We worked on different projects but two come to mind. In 2008 and 2009 he sought my counsel on how he should best present position papers. The first was the 2008 HIV/AIDS Implementers’ Meeting in Kampala (U.S. Global AIDS Coordinator. 2017). This meeting happened to commence on Uganda Martyrs' Day which is June 3rd (Events History). At the National Shrines both the Anglican and the Roman Catholic Church decried homosexuality. The Church's version is that the martyrs never gave in to the King Mwanga's lecherous advances who in anger had them killed by burning (Joanna Bogle, 2015).  By all means the sermons galvanized Ugandans, especially the leaders, to denounce homosexuality in all its forms. In many cases, there were violent incidents and deaths. Between 2008-2012, MARPS in Uganda documented 720 hate related assaults/repeat assaults, 37 house evictions and 7 deaths. One way to deal homosexuality a blow was to deny LGBTIQQ health services. HIV-AIDS in the gay community at that time was decimating many. So, we planned to attend the HIV/AIDS Implementers' Meeting uninvited with the demand that LGBTIQQ be included as beneficiaries of HIV medicines and services in Uganda. The Uganda Police and Security services rounded us up and took some to prison. I managed to escape. 

 The second occasion was when David Kato had to present during the first Public dialogue following the passage of the Anti-Homosexuality Bill (AHB), 2009. David Kato was given only 5 minutes to present amidst heckling and repudiations. When his time came he talked about his qualifications, his experience as a deputy headteacher under one of Ministry of Education's Primary Schools. He showed how this school consistently posted good grades. Then he looked straight into the audience and told us how he had "been a homosexual for over 40 years." He, said, contrary to a myth that was doing the rounds, he "was not dripping and was not wearing a diaper." A silence engulfed the event!  David Kato was a graduate and an experienced educator. In sharing his talk he also gave a rebuttal to what had been said by earlier presenters. By the end of the dialogue, media focus was on David Kato who had packaged pathos, ethos, logos, imagery and personal storytelling to yet again stay the arm that was swiftly proceeding to pass the AHA Bill into an Act. 

In writing this piece, I reflected upon activism, advocacy and how they shaped our friendship with David Kato. I  saw first hand the processes of self-determination by gay persons. I also witnessed the pressures to conform to heterosexual normativity brought on by policy, programming, money, political clout and cultural forces. In Uganda, homosexuality is illegal (RIRs). There are those who are allies to gays, there are those who hate them and then there are those who are gay. Same-sex couples are illegal and there have been many mechanisms to stop what is known as the spread of homosexuality (HRW, 2005). David Kato, epitomizes the clash between existential organic nature, human rights, social justice, religious and political views in an African country. On January 23rd 2017, I heard that David Kato's partner called Yusuf Mukuye was bedridden and had little care. I looked him up. I have just read about the David Kato Vision and Voice Award 2017 (Denis Nzioka, 2016). I am working with over 250 LGBTIQQ-living with HIV in Uganda many of whom we keep in touch using different means. I am going to nominate myself and when I win the award, I shall use it to nurse LGBTIQQ-living with HIV including David Kato's partner. I shall not buy expensive office chairs not glazed tables but I shall make sure every single coin goes to food and medication. Yusuf Mukuye was David Kato's partner and after David's death Yusuf was psychologically traumatized. He sought counselling and after a while we got him a teaching job in South Sudan. While he was there he used his savings plus what we added to buy used desktop computers which he used to teach keyboard typesetting and ran a cafe. Yusuf is a  reserved person who would rather keep to himself. He has HIV which, combined with stress has led him to be bedridden. He needs medication and care since he can no longer work. If you are a friend of David Kato, please help me break and share some bread with his partner who is  a reminder to that enduring memory of David Kato.

References:

Denis Nzioka. 2016. David Kato Vision & Voice Award 2017 - Call for Nominations. Retrieved from: https://www.linkedin.com/pulse/david-kato-vision-voice-award-2017-call-nominations-denis-nzioka?trk=prof-post. Retrieved on January 24th 2017.

FARUG. Freedom and Roam Uganda. Retrieved from: https://faruganda.wordpress.com/. Retrieved on January 24th 2017.


Joanna Bogle. 2015. Unyielding Faith: The Martyrs of Uganda. Retrieved from: https://www.catholicculture.org/culture/library/view.cfm?recnum=8370. Retrieved on January 24th 2017

Events History. n.d. What Happened On 3rd June 2008 In History. Retrieved from: http://www.eventshistory.com/2008-june-3/. Retrieved on January 24th 2017.

Genesis 9. Retrieved from:https://www.biblegateway.com/passage/?search=Genesis+19. Retrieved on January 24th 2017.

GLAD. 2016. Timeline of Anti-Gay Activity in Uganda. Retrieved from: http://www.glad.org/work/cases/uganda-timeline. Retrieved on January 24th 2017.

HRW. 2005. Uganda: Same-Sex Marriage Ban Deepens Repression. Retrieved from: https://www.hrw.org/news/2005/07/12/uganda-same-sex-marriage-ban-deepens-repression. Retrieved on January 24th 2017.

Icebreakers Uganda. Retrieved from: http://icebreakersuganda.com/. Retrieved on January 24th 2017.

Integrity. 2010. Bishop Ssenyonjo resigns from Integrity Uganda. Retrieved from: http://www.newvision.co.ug/new_vision/news/1034683/bishop-ssenyonjo-resigns-integrity-uganda#sthash.i6zOjd63.dpuf. Retrieved on January 24th 2017.

SAHO. 1999. Judge Edwin Cameron of SA reveals that he has been HIV positive since 1987. Retrieved from: http://www.sahistory.org.za/dated-event/judge-edwin-cameron-sa-reveals-he-has-been-hiv-positive-1987. Retrieved on January 24th 2017.

SMUG. Sexual Minorities Uganda. Retrieved from: https://sexualminoritiesuganda.com/. Retrieved on: January 24th 2017.

RIRs. 2007. Treatment of Homosexuals. Retrieved from: https://www.justice.gov/sites/default/files/eoir/legacy/2013/11/07/UGA102197.E.pdf. Retrieved on January 24th 2017.

U.S. Global AIDS Coordinator. 2017. 2008 HIV/AIDS Implementers’ Meeting Opens in Kampala. Retrieved from: https://2006-2009.pepfar.gov/press/2008/105567.htm. Retrieved on January 24th 2017.


Thursday, 26 January 2017

What we mean when we say END TO HIV; communicating appropriately



  1. Prevention & Control Infrastructure needed for providing services
  2. Community Mobilization and Organization
  3. Testing to know one’s status
  4. Attending clinic for individual assessment
  5. Checking for or treating opportunistic infections
  6. Checking for other viral infections
  7. Pap smears
  8. Screening for cancer ( breast, anal, oral, lung, prostate….)
  9. Support to quit smoking
  10. Health education
  11. Provision of Information, education and Communication materials
  12. Access to safe motherhood services
  13. Access to Mother and Child Health Services
  14. Diabetes screening
  15. STIs screening
  16. UTI screening
  17. Anal screening
  18. Pregnancy testing
  19. Treatment for STIs/UTIs
  20. Physicals
  21. Mammograms
  22. High blood screening
  23. Mental health care
  24. Referral services
  25. Tetanus vaccination
  26. Thyroid screening
  27. Anaemia testing
  28. Modernizing Criminalization laws
  29. Engaging in bursting stigma
  30. Engaging in bursting discrimination
  31. Acknowledging and recognizing what works
  32. Trickle down services to individual recipient
  33. Trained health care provider
  34. SRH-specific needs
  35. Family planning needs
  36. Gender-specific planning needs
  37. Traditional public health
  38. social interventions
  39. Biomedical approaches to HIV and integration of services with broader health systems
  40. Zero HIV-related deaths; zero-stigma; zero discrimination

On The verge of Homelessness In a country That is Preparing for Elections, Refugees Are Wondering When the Next Cheque Will Come To Enable Them Pay Rent





                    About to be evicted for 4 months back rent, refugees sought support from UNHCR (Photo courtesy of Alia Adams)



The landlord, had always been distant, kind, patient and tolerant. It is the wife who sometimes would prepare a Kenyan dish which she shared with the people who rented one of their small 2 bedroom house. She was the face they saw most of the times and she reminded them of all mothers. 

The landlord lives nearby in a bigger 5 bedroom house so it is not uncommon for someone from the landlord’s home to come and ask them for a helping hand or run errands. 

Matasia, Ngong is an exclusive part of Nairobi Capital City. A part of a larger escarpment so many feet above sea level. The climate and rich soils allow the lush green leaved trees to grow to very large sizes. The neighbourhood is considered urban and the roads are paved. It is the serene setting out of glossy magazines. To have this place, they pooled together money they got as allowances to pay for rent. Here they feel they are treated with dignity. 

So far, they have never regretted the decision. Here, they feel so welcome. In return they arrange to clean the grounds in the front and backyard, they take initiative to cut any shrubs and collect litter which is usually blown by the winds. This peace of mind and a semblance of normalcy was possible only because HIAS provides  the money which they pooled together to pay rent and buy food. 

But, nothing prepared Mathias(26), Sulaiman (30), Zacchaeus (24), Raphael (23), Michael (25) and  Ziporah (25) (not real names) when they  were roused from bed last night, by a really loud knock which they guessed, right, was from the landlord who on opening the entrance gate demanded for the month’s rent which has been late coming and left without saying anything else.


One of the posters the refugees came with to UNHCR Offices in Westlands Nairobi (Photo courtesy of Alia Adams)


Raphael and Michael are transgender persons who left Uganda following death threats from their own family members for being gay. In the case of Ziporah, she had to leave university where she was about to complete a physical science course. She was warned by a friend that she was outed in a tabloid and that on seeing this her roommates at the hostel where she was staying threw her belongings out. That very day, she got on a bus, left Kampala. She arrived in Nairobi (Kenya) about 660 kilometers away the following day hungry but thankful she had saved her life. 



Fearing they may be evicted out of their houses, refugees gathered together to get an explanation on delayed cheques (Photo courtesy of Alia Adams)


Sulaiman is living with HIV and this group has been the support team encouraging him to take his medication and meals on time. Sulaiman was diagnosed with HIV in 2015, 2 months after he had arrived in Kenya. In Uganda, he was living with his boyfriend. One scary night, they heard a rowdy gathering of people outside their rented house in Uganda. The crowd was demanding loudly why two men were always together in the same house without women. The crowd alleged they were practicing homosexuality and because of that they threatened to burn the house. Sulaiman was lucky to escape and up to now he does not know the whereabouts of his partner. Zacchaeus and Mathias are partners who are at their final stage of the resettlement process. 


Refugees outside the UNHCR Offices contemplating the next steps in case they are evicted from their houses for not paying rent (Photo courtesy of Alia Adams).


Raphael the team’s leader has always struck me as strong hearted and does not easily break down. But, this time he called me with sobs interspersed between coherence statements about the condition they were facing.


 “ Doctor, doctor, help us please we are about to lose our house and you have always helped us since 2013……sob …..HIAS, has always been generous and provided us money on time………..sob……but this time around……sob……. they haven’t provided us with money and we are about to lose our home ..sob……sob……….sob ……..”


Sulaiman was more composed so he took over the phone, gave me the fuller details and sent in some pictures. 


The plight of Ugandan refugees in Kenya should not be taken lightly especially now that they have stayed in Kenya for quite some time. They have fallen into regular patterns of life and a stable home is one important stage in their lives. Sulaiman adds:

“Doctor Tom….. we are so grateful to HIAS, UNHCR, all other organizations such as the Dutch Refugee Council and the Kenyan Government for the support they render to us. We promised to be law abiding but when one loses a house life is disrupted. Kenya is preparing for Presidential elections. In the interests of security and safety we need to be out of so many peoples’ ways. These are delicate times. As an HIV+ve refugee I do not want to even think of what may be disrupted in my life once we lose this house. Doctor, if possible please talk to your friends who can in turn talk to the HIAS people. Please let them send us money to support us. Thank you so much.”

Refugees outside the UNHCR Country Representative in Kenya Offices in Westland Nairobi (Photo courtesy of Alia Adams)


This appeal goes to whoever is reading this article and seeing the pictures to help these refugees by reaching out to HIAS and ask them to, please, provide the money as they have always been kindly doing. Otherwise, the refugees face eviction from their houses. 

For further details reach me on: +1415-410-8340, ask for Thomas. Thank you so much.











Wednesday, 25 January 2017

Meaningful Involvement of People Living with HIV using Social Marketing, Media Advocacy and Community Organizing

A friend asked me to point out crucial relations between the language we use as we provide effective healthcare services in particular for People living with HIV. I suggested it was no less a language thing as much as it is mobilizing beneficiaries and providers around ensuring delivery of services that promote healthy outcomes. These can be the beginnings of a policy change itself. Social marketing, media advocacy and community organizing can be used to promote meaningful involvement of people living with HIV (PLHIV). It can be made an effective empowerment mechanism in giving feedback on how PLHIV are impacted by services they require e.g., health care, medication, housing, communication and modernization of policy. In using the three approaches, there are inbuilt advantages including cultural competency (Bentacourt J.R. 2005), tackling stigma and improving the quality of life for those living with HIV.
Through social marketing it is possible to influence practices at different levels e.g., decision-making; experts; implementers; speakers; contributors; target audiences (who are almost always not realized to be the subject matter (illnesses) experts). Social marketing, provides opportunities to implement practices by: accepting a new behavior, e.g., health facilities coming up with say, support meetings and regularized events for people living with HIV; reject a potential undesirable behavior, e.g., adopt language that is not stigmatizing of PLHIV; modify a current practice or behavior, e.g., encourage input in planning and managing of services by PLHIV; abandon an old undesirable behavior, e.g., using preferred language to reduce stigmatization of PLHIV such as adopting the use of terms like mixed status couple/serodifferent and not serodiscordant or use a people first language that emphasizes the person and not their diagnosis (Lynn V. 2016). Social marketing analyses neighborhoods or key populations and provides appropriate interventions (Farr, M., 2008). Social marketing promotes participation of consumers in designing mechanisms for airing out their own needs. It is also a mechanism for soliciting solutions from consumers. It sets the stage for healthy outcomes for all population groups and operationalizes policy for well being in society. Social marketing applies principles and techniques to create, communicate and deliver value to influence target audience practices or behaviors that benefit society and target audience (Correil, J., 2010) . For it to be effective, it employs the 4 P’s marketing mix strategies. By 4 P’s is meant: product; price; place; and promotion. It integrates the 4 P’s in any behavior change, maintenance or adoption strategy. Social marketing is employed in the following areas:
1. Health promotion-related issues such as: housing, fruit and vegetable intake, heavy binge/drinking, safety in cars, drinking and driving, storage of dangerous materials in homes, tobacco use, breastfeeding, obesity, teen pregnancy, STI’s prevention, oral health, immunization, diabetes, eating disorders and blood pressure.
2. Injury-prevention related behavioral issues such as: syringe exchange sites, decriminalization, safety in cars, drinking and driving, storage of dangerous materials in homes, avoiding falls in buildings, gun storage, domestic violence, injuries, drowning and suicides.
3. Environmental protection- related behavioral issues such as: waste reduction, wild life habitat protection, forest destruction, toxic fertilizers and pesticides, water conservation, air pollution, litter, avoiding unintentional fires and energy conservation.
4. Community mobilization-related behavioral issues such as: safe drinking water campaigns, mosquito net use, decriminalization of HIV, blood donation, literacy, voting, animal adoption, increase utilization of public health services, combat chronic diseases and promote healthy living.
Media Advocacy, is when different communication means are utilized to deliver a message/s that promote/s healthy outcomes (Pérez, L., & Martinez, J. 2008). The communication means can be such as: news broadcast, social media, instant messaging, advertising, skits, information bulletins, public relations, social events, public meetings, exhibitions, sponsorships and use of platforms to continue with a given conversation on healthy outcomes.
Community organizing, is effective when communities are mobilized to address certain issues as well as empowered to participate in decision-making. This is effectively done when pretesting/piloting, monitoring and evaluation are integrated in the strategies or initiatives (Pulliam, R. 2009). Community organizing is influenced by the social, cultural and regulatory environments prevailing to maximize effectiveness. The events around which organizing occurs may range from: modernizing laws, immunizations to treating Hepatitis. Community organizing is done to yield behavior change or maintain a positive practice (Galer-Unti, R. A., Tappe, M. K., & Lachenmayr, S. 2004). For meaningful involvement of people living with HIV, organizing is done around: core practice; actual practice; and augmented practice. The core practice in this case is: providing empowerment for PLHIV to articulate correctly issues pertaining to them in an intervention planning event. The actual practice will be: creating space at the table for PLHIV to bring their expertise. The augmented practice in this case can be: hearing first hand accounts that can be used to inform planning and policy.
References:

Betancourt, J. R., Green, A. R., Carrillo, J. E., & Park, E. R. (2005). Cultural competence and health care disparities: Key perspectives and trends. Health Affairs, 24(2).

Coreil, J. (Ed.). (2010). Social and behavioral foundations of public health (2nd ed.). Thousand Oaks, CA: Sage.
Farr, M., Wardlaw, J., & Jones, C. (2008). Tackling health inequalities using geodemographics: A social marketing approach. International Journal of Market Research, 50(4), 449–467. Retrieved from the Walden Library databases.
Galer-Unti, R. A., Tappe, M. K., & Lachenmayr, S. (2004). Advocacy 101: Getting started in health education advocacy. Health Promotion Practice, 5(3), 280–288. Retrieved from the Walden Library databases.
Pérez, L., & Martinez, J. (2008). Community health workers: Social justice and policy advocates for community health and well-being. American Journal of Public Health, 98(1), 11–14. Retrieved from the Walden Library databases.
Pulliam, R. (2009). Developing your advocacy plan. Health Education Monograph Series, 26(1), 17–23. Retrieved from the Walden Library databases.
Vickie Lynn, Valerie Wojciechowicz. 2016. HIV Communication: Using Preferred Language to Reduce Stigma.

Empowering Young MSM born with HIV (YMSMPoz) to communicate SRH preferences appropriately can reveal other vulnerabilities

Empowering Young MSM born with HIV (YMSMPoz) to communicate SRH preferences appropriately can reveal other vulnerabilities


MARPS in Uganda created the #YMSMPoz as an internet ribbon cutting ceremony to celebrate working with 278 HIV positive sexually active Young MSM below 35 years. 97 of them are 25-29 years; 81 are between 22-25 years; and 100 are between 17-22 years. All 278 are taking medications. 175 do not identify as LGBTIQQ. 180 use some form of substances. All of them have missed their medications at one time in the previous six months. 189 engage in a form of talent and performing art but, have had no chance of exploring their talents under a more talented mentor or instructor.

YMSMPoz has been a culmination of events. In 1997, we worked as an orphan support organization in Uganda and by 1997 had 25 young children living with HIV we were caring for. We could not look after the children so we handed them over to another organization as we were changing our objectives to work with MSM. In 2000, some of the former children came back to us, revealed they were sexually active and regularly engaged in unprotected anal sex with other boys. This was in the suburbs of Kampala City Authority. We later found out that there are many more abandoned children on the streets who were engaging in unprotected survival sex. We have  since worked with many more but we do need to be supported. We want to provide condoms, other birth-control methods and provide appropriate referral for those who want to have expressed the desire to have children.

It is important to formalize formation of a viable YMSMPoz support club; we shall use the platform for empowerment to communicate SRH needs appropriately; and establish the YMSMPoz support center for former male street children who have sex with men. Developing unique information, education and communication materials on the intersection of homelessness, will help inform policy and programming targeting survival sex-work and HIV in Uganda. Writing using simple and easy to read English provides information which is accessible and a service to make beneficiaries informed consumers. 

MARPS In UGANDA’s LGBTIQQ sexual and reproductive health (SRH) package focuses on three priority areas (Individual needs/ expectations of services/ Influences of the larger community: 
  1. Integrating gender and sexual choices, childbearing choices, maternal and newborn care skills
  2. Services for preventing and managing sexually transmitted infections/ hematological(blood), oral, vaginal and anal infections
  3. Engaging in support mechanisms to align pressures with the goal of healthy outcomes

BACKGROUND:

In Uganda, SRH package delivered through primary health care ((Katherine Williams, Charlotte Warren & Ian Askew. 2010) with referrals and has the following standards of care:

  • Family planning/birth spacing services
  • Antenatal care, skilled attendance at delivery, and postnatal care
  • Management of obstetric and neonatal complications and emergencies
  • Prevention of abortion and management of complications resulting from unsafe
abortion
  • Prevention and treatment of reproductive tract infections and sexually transmitted
infections including HIV/AIDS
  • Early diagnosis and treatment for breast and cervical cancer
  • Promotion, education and support for exclusive breast feeding
  • Prevention and appropriate treatment of sub-fertility and infertility
  • Active discouragement of harmful practices such as female genital cutting
  • Adolescent & Adult sexual and reproductive health
  • Prevention and management of gender-based violence.

YMSMPoz, is a unique platform and knowledge hub for a section of population fast gaining in numbers in Uganda. The youth who were born with HIV and those who have had anal sexual intercourse are the target for this service. It is our hope this will improve decision-making for quality health outcomes. As part of building a prevention and care movement in Uganda, we shall leverage our linkages through the 6 building blocks around which health services are provided in Uganda. These blocks are:


1. Service Delivery: continue exploring how best service can be available in form of friendly, effective, safe and quality interventions for improving SRH status;
2. Human Resources: to empower youths to engage in self-care awn well seek medical care to achieve the best health;
3. Health Information: to use reliable and timely information on health system performance, as well as health determinants and status;
4. Medicines and Technologies: to ensure equitable access to products and technologies that are of assured quality, safety, efficacy and cost-effectiveness;
5. Health Financing: to provide opportunities to young consumers to use needed services and are protect them from impoverishment through having to pay for them.
6. Leadership and Governance: to ensure a strategic policy framework exists, together with effective oversight and accountability.


Tailored Services:

Education services and gender planning (biological and cultural genders)
Education and services on gender and sexual planning
Education and services on voluntary family planning information
Education and services on healthcare including HIV/HPV testing and management
Education and services on anal cancer screening. Hostility to men-who-sex-with-men seeking health services is documented (SMUG, 2015). However, MARPS IN UGANDA, has medical doctors who can be facilitated to provide anal-health care services.
Education and services on sexuality, orientation, gender and identity (conforming and non-conforming identities)
Education  and services on gender-based violence like correction-rape, genital mutilation, early and forced marriage. Anti-gay movements create hostile climate which demotivates service providers, drives beneficiaries underground and raises acts of violence toward LGBTIQQ. Uganda criminalizes homosexuality but as a signatory to the UN Declaration of Human Rights it is called upon to uphold human rights standards. All persons have a duty to seek out information or counsellors with training to guide them as they make SRH plans and choices. There are different organizations in Uganda with qualified health educators and counsellors. One such organization is Spectrum Uganda Initiatives (Spectrum Uganda Initiative).



YMSMPoz Counselling Package involves:
  • Sexuality, Orientation, Gender and Identity Counselling
  • Individually-tailored assessment for better health outcomes provides opportunities to meet SRH needs at individual levels and open ways for referral (Lambda Legal)
  • Provision of education or services on HIV/AIDS & STIs




Conclusion:

Working with YMSM, most especially those living with HIV, reveals overarching aspects. There is potential in the talent and performing arts are;  overty, stigma and poor adherence (Michaela Kerrissey, 2008); there are those who engage in survival sex-work who may or may not be identifying as LGBTIQQ; and there are those who are living with HIV. Barriers facing YMSMPoz on the road to quality SRH outcomes, include those faced by the LGBTIQQ. However, tapping into the performing art area can help build the ethos, pathos and logos of Uganda's young persons in pursuing quality life and wellness.







Reference:

Katherine Williams, Charlotte Warren, and Ian Askew. 2010. Planning and Implementing
an Essential Package of Sexual and Reproductive Health Services; Guidance for Integrating Family Planning and STI/RTI with other Reproductive Health and Primary Health Services:.Retrieved from: http://www.unfpa.org/sites/default/files/resource-pdf/Essential_Package_Integration.pdf. Retrieved on January 24th 2017.


Lambda Legal. Know Your Rights. Retrieved from: http://www.lambdalegal.org/know-your-rights/article/trans-parents. Retrieved on January 224th 2017.


Michaela Kerrissey, 2008. Adolescents Living with HIV in Uganda:  Factors Affecting Disclosure, Adherence, and Prevention. JCRC, Uganda

SMUG. 2015. Why anti-gay sentiment remains strong in much of Africa. Retrieved from: https://sexualminoritiesuganda.com/why-anti-gay-sentiment-remains-strong-in-much-of-africa/. Retrieved on January 24th 2017.

SMUG. 2015. Testimonies of Human Rights Abuses From Uganda’s Sexual and Gender Minorities. Retrieved from: https://sexualminoritiesuganda.com/wp-content/uploads/2016/04/And-Thats-How-I-Survived_Report_Final.pdf. Retrieved on January 25th 2017.


Spectrum Uganda Initiative. Retrieved from: http://www.spectrumuganda.net/. Retrieved on January 24th 2017. 

Friday, 20 January 2017

We have come a long way since 2004

In 1997, we were the Good Samaritan Uganda. But on January 20th 2004, six days before the NRM day, we came up with an organization to help look after disowned LGBT. Little did we know we would become MARPS in Uganda.

2004-2005
1. We are invited to join Icebreakers and SMUG.
2. We get a small three-bedroom house, we use it as a resource center and clinic eventually.
3. We had our first eviction from the house we used as our resource center toward the end of 2005 for allowing LGBTIQQ to "offend" the neighbourhood.
4. We moved to another location and by December 1st World AIDS Day, we had 23 LGBT-living with HIV.

2006-2008
1. We continued with our work around self determination of LGBTIQQ
2. We were part of other organizations (FARUG, Good Samaritan, Icebreakers, KULHAS, Spectrum) which "stormed" an HIV conference in Kampala and demanded for LGBTIQQ issues to be included in HIV Planning.
3. We were part of the organizations that picketed at the Centenary Park near Hotel Africana during the "CHOGM" conference and demanded for repealing of laws that stigmatized and discriminated against LGBTIQQ, Sex-workers, People living with HIV and MARPs.
4. We approached some religious organizations that preached hate and we talked about how this was dangerous.
5. We attended the first Anti-Gay conference organized by a section of the Religious Civil Society and we sought an audience to speak about sexuality, orientation, gender, identity and health.
6. Documented abuses and HIV cases among LGBTIQQ Community
7. We designed the first ever mental health/Public Health Strategic Plan targeting LGBTIQQ persons.
8. We collaborated with different research organizations which we linked to respondents.

2009-2011
1. The passing of the Anti-homosexuality Act
2. The passing of the Amended Equal Opportunities Act
3. Chaos, hate, beatings, evictions, more HIV/STI cases among LGBTIQQ
4. Identified health facilities ready to provide ARVs to our beneficiaries
5. Continued our backpack method of community home visits

2012-2014
1. After effects of Anti-Homosexuality Act (AHA)
2. Repealing of AHA successful
3. Increased hate-related abuses toward LGBTIQQ
4. Most of our clients died due to lynching, AIDS and suicide
5. Increased displacement, abandonment and disowning of LGBTIQQ by parents or relatives
6. Asylum and Refugee paths
7. Continued our backpack method of community home visits

2015-2017
1. Evictions
2. Backpack, Foot and motorbike community health care services
3. Working out of a car
4. Working out of a 1 bedroom house
5. Linking over 200 LGBT-living with HIV to care
6. Continued our backpack method of community home visits
7. Increased displacement, abandonment and disowning of LGBTIQQ by parents or relatives
8. New LGBT-living with HIV cases